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Reconnection of floodplains to rivers to enhance fluvial dynamics is a favored method of floodplain restoration in Europe. It is believed that the restoration of hydrological conditions of the floodplain facilitates natural dispersal of target species, and hence the reestablishment, of typical plant communities. The aim of our study was to investigate whether floodplain target species could reach restoration sites via hydrochorous dispersal. We analyzed seed inflow from the river and seed dispersal in different sectors of a new watercourse in the Danube floodplain. Seeds were captured using 27 seed traps during three sampling periods of 3 weeks each from summer 2011 to spring 2012. After germination seedlings were identified, we detected a total of almost 39,000 seeds of 176 species, including 80 target species of riparian habitats. We found significant differences between seasons (most seeds in autumn/winter) and between stream sectors. Fewer seeds came in from the Danube (2,800 seeds) than were transported within the floodplain. Several new floodplain target species were detected, which had not been found in the aboveground vegetation or soil seed bank before the start of the restoration. Seeds of nonnative species did not disperse further than approximately 1 km. Our results indicated that hydrochorous seed dispersal from upstream habitats along the new watercourse was important for the establishment of target species and hence for the success of floodplain restoration. Technical water diversion weirs must be traversable for seeds, and small donor sectors upstream might enhance the reestablishment of target vegetation along new sectors downstream.
Purpose
This study operationalizes risks in stakeholder dialog (SD). It conceptualizes SD as co-produced organizational discourse and examines the capacities of organizers' and stakeholders' practices to create a shared understanding of an organization’s risks to their mutual benefit. The meetings and online forum of a German public service media (PSM) organization were used as a case study.
Design/methodology/approach
The authors applied corpus-driven linguistic discourse analysis (topic modeling) to analyze citizens' (n = 2,452) forum posts (n = 14,744). Conversation analysis was used to examine video-recorded online meetings.
Findings
Organizers suspended actors' reciprocity in meetings. In the forums, topics emerged autonomously. Citizens' articulation of their identities was more diverse than the categories the organizer provided, and organizers did not respond to the autonomous emergence of contextualizations of citizens' perceptions of PSM performance in relation to their identities. The results suggest that risks arise from interactionally achieved occasions that prevent reasoned agreement and from actors' practices, which constituted autonomous discursive formations of topics and identities in the forums.
Originality/value
This study disentangles actors' practices, mutuality orientation and risk enactment during SD. It advances the methodological knowledge of strategic communication research on SD, utilizing social constructivist research methods to examine the contingencies of organization-stakeholder interaction in SD.
Stainless steel made to rust: a robust water-splitting catalyst with benchmark characteristics
(2015)
The oxygen evolution reaction (OER) is known as the efficiency-limiting step for the electrochemical cleavage of water mainly due to the large overpotentials commonly used materials on the anode side cause. Since Ni–Fe oxides reduce overpotentials occurring in the OER dramatically they are regarded as anode materials of choice for the electrocatalytically driven water-splitting reaction. We herewith show that a straightforward surface modification carried out with AISI 304, a general purpose austenitic stainless steel, very likely, based upon a dissolution mechanism, to result in the formation of an ultra-thin layer consisting of Ni, Fe oxide with a purity >99%. The Ni enriched thin layer firmly attached to the steel substrate is responsible for the unusual highly efficient anodic conversion of water into oxygen as demonstrated by the low overpotential of 212 mV at 12 mA cm−2 current density in 1 M KOH, 269.2 mV at 10 mA cm−2 current density in 0.1 M KOH respectively. The Ni, Fe-oxide layer formed on the steel creates a stable outer sphere, and the surface oxidized steel samples proved to be inert against longer operating times (>150 ks) in alkaline medium. In addition Faradaic efficiency measurements performed through chronopotentiometry revealed a charge to oxygen conversion close to 100%, thus underpinning the conclusion that no “inner oxidation” based on further oxidation of the metal matrix below the oxide layer occurs. These key figures achieved with an almost unrivalled-inexpensive and unrivalled-accessible material, are among the best ever presented activity characteristics for the anodic water-splitting reaction at pH 13.
While developing traffic-based cognitive enhancement technology (CET), such as bike accident prevention systems, it can be challenging to test and evaluate them properly. After all, the real-world scenario could endanger the subjects’ health and safety. Therefore, a simulator is needed, preferably one that is realistic yet low cost. This paper introduces a way to use the video game Grand Theft Auto V (GTA V) and its sophisticated traffic system as a base to create such a simulator, allowing for the safe and realistic testing of dangerous traffic situations involving cyclists, cars, and trucks. The open world of GTA V, which can be explored on foot and via various vehicles, serves as an immersive stand-in for the real world. Custom modification scripts of the game give the researchers control over the experiment scenario and the output data to be evaluated. An off-the-shelf bicycle equipped with three sensors serves as a realistic input device for the subject’s movement direction and speed. The simulator was used to test two early-stage CET concepts enabling cyclists to sense dangerous traffic situations, such as trucks approaching from behind the cyclist. Thus, this paper also presents the user evaluation of the cycling simulator and the CET used by the subjects to sense dangerous traffic situations. With the knowledge of the first iteration of the user-centered design (UCD) process, this paper concludes by naming improvements for the cycling simulator and discussing further research directions for CET that enable users to sense dangerous situations better.
In modern times, closed-loop control systems (CLCSs) play a prominent role in a wide application range, from production machinery via automated vehicles to robots. CLCSs actively manipulate the actual values of a process to match predetermined setpoints, typically in real time and with remarkable precision. However, the development, modeling, tuning, and optimization of CLCSs barely exploit the potential of artificial intelligence (AI). This paper explores novel opportunities and research directions in CLCS engineering, presenting potential designs and methodologies incorporating AI. Combining these opportunities and directions makes it evident that employing AI in developing and implementing CLCSs is indeed feasible. Integrating AI into CLCS development or AI directly within CLCSs can lead to a significant improvement in stakeholder confidence. Integrating AI in CLCSs raises the question: How can AI in CLCSs be trusted so that its promising capabilities can be used safely? One does not trust AI in CLCSs due to its unknowable nature caused by its extensive set of parameters that defy complete testing. Consequently, developers working on AI-based CLCSs must be able to rate the impact of the trainable parameters on the system accurately. By following this path, this paper highlights two key aspects as essential research directions towards safe AI-based CLCSs: (I) the identification and elimination of unproductive layers in artificial neural networks (ANNs) for reducing the number of trainable parameters without influencing the overall outcome, and (II) the utilization of the solution space of an ANN to define the safety-critical scenarios of an AI-based CLCS.
The deployment of containers as building modules has grown in popularity over the past years due to their inherent strength, modular construction, and relatively low cost. The upcycled container architecture is being accepted since it is more eco-friendly than using the traditional building materials with intensive carbon footprint. Moreover, owing to the unquestionable urgency of climate change, existing climate-adaptive design strategies may no longer respond effectively as they are supposed to work in the previous passive design. Therefore, this paper explores the conceptual design for an upcycled shipping container building, which is designed as a carbon-smart modular living solution to a single family house under three design scenarios, related to cold, temperate, and hot–humid climatic zones, respectively. The extra feature of future climate adaption has been added by assessing the projected future climate data with the ASHRAE Standard 55 and Current Handbook of Fundamentals Comfort Model. Compared with the conventional design, Rome would gradually face more failures in conventional climate-adaptive design measures in the coming 60 years, as the growing trends in both cooling and dehumidification demand. Consequently, the appropriate utilization of internal heat gains are proposed to be the most promising measure, followed by the measure of windows sun shading and passive solar direct gain by using low mass, in the upcoming future in Rome. Future climate projection further shows different results in Berlin and Stockholm, where the special attention is around the occasional overheating risk towards the design goal of future thermal comfort.
Currently, the modelling of drying processes of plant tissues pre-treated by pulsed electric field (PEF) is following experimentally identified curves or separate heat and mass transfer and diffusion models with different levels of accuracy. This research had two major objectives: mathematical modeling and control of drying process of different vegetables pretreated by PEF during convective drying. The mathematical modeling was based on Luikov's heat and mass transfer model along with properties of different vegetables. Computer modelling was done using the difference method for predicting moisture and the temperature potentials of untreated and PEF-treated vegetables. The formulation and the solution procedures were applied to simulate the simultaneous heat and mass transfer in selected vegetables subjected to the convective drying. Suggested model had a good correlation with experimental results. Moreover, cell disintegration index can be used as a controllable parameter in heat and mass transfer models to predict drying behavior of potato, onion, and carrot tissues. Obtained drying models can be used as a mathematical tool to predict drying behavior for various types of agricultural products pre-treated by pulsed electric field.
The kiwifruit processing industry is focused on product yield maximization and keeping energy costs and waste effluents to a minimum while maintaining high product quality. In our study, pulsed electric field (PEF) pretreatment enhanced kiwifruit processing to facilitate peelability and specific peeling process and enhanced valorization of kiwifruit waste. PEF optimization was applied to obtain the best treatment parameters. A 32 factorial design of response surface methodology was applied to find the effect of time elapsed after PEF treatment and the PEF-specific energy input on specific peeling force and kiwifruit firmness as response criteria. Under the optimized condition, the specific peeling force decreased by 100, and peelability increased by 2 times. The phenolic content and antioxidant capacity of PEF-treated kiwifruit bagasse were 5.1% and 260% richer than the control sample. Overall, the optimized PEF pretreatments incorporated into kiwifruit processing led to decreased energy demand and increased productivity.
Background
To detect changes in biological processes, samples are often studied at several time points. We examined expression data measured at different developmental stages, or more broadly, historical data. Hence, the main assumption of our proposed methodology was the independence between the examined samples over time. In addition, however, the examinations were clustered at each time point by measuring littermates from relatively few mother mice at each developmental stage. As each examination was lethal, we had an independent data structure over the entire history, but a dependent data structure at a particular time point. Over the course of these historical data, we wanted to identify abrupt changes in the parameter of interest - change points.
Results
In this study, we demonstrated the application of generalized hypothesis testing using a linear mixed effects model as a possible method to detect change points. The coefficients from the linear mixed model were used in multiple contrast tests and the effect estimates were visualized with their respective simultaneous confidence intervals. The latter were used to determine the change point(s). In small simulation studies, we modelled different courses with abrupt changes and compared the influence of different contrast matrices. We found two contrasts, both capable of answering different research questions in change point detection: The Sequen contrast to detect individual change points and the McDermott contrast to find change points due to overall progression. We provide the R code for direct use with provided examples. The applicability of those tests for real experimental data was shown with in-vivo data from a preclinical study.
Conclusion
Simultaneous confidence intervals estimated by multiple contrast tests using the model fit from a linear mixed model were capable to determine change points in clustered expression data. The confidence intervals directly delivered interpretable effect estimates representing the strength of the potential change point. Hence, scientists can define biologically relevant threshold of effect strength depending on their research question. We found two rarely used contrasts best fitted for detection of a possible change point: the Sequen and McDermott contrasts.
Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.
Chronic illness can have a profound impact on couples’ relationships. In dealing with relational changes, new constructions and forms of relationships may arise. In the context of a larger grounded theory study on relational processes and practices in couples faced with chronic illness, this article focuses on concurrent relationships as an alternative form of relationship construction which embodies an additional relationship existing parallel to that of the couple confronted with chronic illness. Based on qualitative interviews with a subsample of five persons within the larger study, conditions for the development and characteristics of concurrent relationships are presented. From an individual and shared life questioned by chronic illness, concurrent relationships are formed in the attempt to be able to live on together in a new partner relationship and a continued care relationship. This can lead to new constructions of relationships, family life, and social relations in everyday life.
Quantitative Umweltbewertungen sind von entscheidender Bedeutung, wenn es darum geht, effektiv auf nachhaltige Produktions- und Verbrauchsmuster hinzuarbeiten. In den letzten Jahrzehnten haben sich Lebenszyklusanalysen (LCA) als praktikables Mittel zur Messung der Umweltauswirkungen von Produkten entlang der Lieferkette etabliert. In Bezug auf Nutzer- und Konsummuster wurden jedoch methodische Schwächen festgestellt, und es wurden mehrere Versuche unternommen, Ökobilanzen entsprechend zu verbessern, beispielsweise durch Einbeziehung von Effekten höherer Ordnung und verhaltenswissenschaftlicher Unterstützung. In einer Diskussion solcher Ansätze zeigen wir, dass den Konzepten des Verbrauchs keine explizite Aufmerksamkeit geschenkt wurde, was häufig zu produktzentrierten Bewertungen führt. Wir führen Theorien sozialer Praktiken ein, um Konsummuster für LCA zugänglich zu machen. Soziale Praktiken sind routinierte Handlungen, die aus miteinander verbundenen Elementen (Materialien, Kompetenzen und Bedeutungen) bestehen, die sie als eine Einheit denkbar machen (z. B. Kochen). Da die meisten sozialen Praktiken eine Art von Verbrauch (Material, Energie, Luft) beinhalten, konnten wir einen Rahmen entwickeln, der soziale Praktiken mit der Ökobilanz verbindet. Der vorgeschlagene Rahmen bietet eine neue Perspektive für quantitative Umweltbewertungen, indem er den Schwerpunkt von Produkten oder Nutzern auf soziale Praktiken verlagert. Dementsprechend sehen wir die Chance darin, die reduktionistische Sichtweise zu überwinden, dass Menschen nur Nutzer von Produkten sind, und sie stattdessen als Praktiker in sozialen Praktiken zu sehen. Dieser Wandel könnte neue Methoden der interdisziplinären Konsumforschung ermöglichen, die beabsichtigte Sozialwissenschaften und wirkungsorientierte Bewertungen einbeziehen. Allerdings bedarf der Rahmen einer weiteren Überarbeitung und vor allem einer empirischen Validierung.
Jede Ernährung hat Auswirkungen auf den Gesundheitszustand des Einzelnen, auf die Umwelt und auf soziale Belange. Eine wachsende Zahl von Mahlzeiten wird in der Außer-Haus-Verpflegung eingenommen, in der eine systematische Nachhaltigkeitsbewertung nicht zur gängigen Praxis gehört. Um diese Lücke zu schließen, wurde im Rahmen des NAHGAST-Projekts ein Instrument entwickelt. Nach mehr als einem Jahr des Einsatzes des NAHGAST-Online-Tools soll nun überprüft werden, welche positiven Umwelteinflüsse durch den Einsatz des Instruments realisiert werden können. Aus diesem Grund befasst sich dieser Artikel mit der Frage, ob ein Online-Tool Akteure aus dem Bereich des Außer-Haus-Verzehrs in die Lage versetzen kann, ihre Mahlzeiten im Hinblick auf Aspekte einer nachhaltigen Ernährung zu überarbeiten. Darüber hinaus wird die Frage beantwortet, wie sich konkrete Rezeptüberarbeitungen der beliebtesten Mittagsgerichte auf den materiellen Fußabdruck sowie auf den Carbon Footprint auswirken.
Zusammenfassend lässt sich sagen, dass ein Online-Tool individuelle Nachhaltigkeitspfade für Akteure im und ermöglicht eine eigenständige Rezeptüberarbeitung für bereits bestehende Gerichte. Mahlzeiten. Die Ergebnisse zeigen, dass bereits geringfügige Änderungen in den Rezepten zu Einsparungen von bis zu einem Drittel führen können beim CO2-Fußabdruck sowie beim Materialfußabdruck führen können. Bezogen auf den Außer-Haus-Verzehr Außer-Haus-Verzehr ergibt sich daraus das Potenzial für erhebliche Multiplikationseffekte, die den Weg für die Verbreitung von nachhaltiger Ernährung ebnen.
In einer konsumorientierten Kultur ein Leben der Suffizienz zu führen, ist vielleicht eines der ehrgeizigsten Experimente, die ein Mensch unternehmen kann. Um diese Herausforderung zu untersuchen, haben wir einen sozial-praktischen Ansatz gewählt. Dieser Artikel basiert auf 42 qualitativen Interviews, in denen die Befragten gefragt wurden, warum und wie sie sich in einer westlichen Infrastruktur und Kultur suffizient verhalten. Die Ergebnisse deuten darauf hin, dass Suffizienz-orientierte Menschen bei ihren ressourcenintensiven Handlungen auf bestimmte Bedeutungen in der Alltagspraxis zurückgreifen. Diese Bedeutungen umfassen eine Mischung aus umweltfreundlichen Einstellungen, positiven sozialen Absichten und/oder persönlichen Verpflichtungen zur Sparsamkeit. Darüber hinaus haben wir eine Reihe spezifischer Praktiken identifiziert, darunter Teilen, Recycling und Wiederverwendung, die für einen ressourcenschonenden Lebensstil nützlich sind. Für unsere Befragten sind viele dieser Suffizienz-Praktiken regelmäßig im täglichen Leben anzutreffen und wurden nur selten hinterfragt. Anhand einer zusätzlichen Umfrage zeigen wir, dass diese Routinen zu einem weniger ressourcenintensiven Lebensstil führen und wie es einer kleinen Gruppe von Menschen gelungen ist, sich Suffizienzpraktiken anzugewöhnen. Die Mehrheit sieht jedoch keine Notwendigkeit für eine häufigere Umsetzung solcher Routinen, da die täglichen Entscheidungsprozesse weitgehend auf den Konsum von Produkten ausgerichtet sind.
Der Bereich Ernährung wird in den kommenden Jahrzehnten vor zahlreichen Herausforderungen stehen, die sich aus den veränderten Lebensgewohnheiten und globalen Konsummustern bei gleichzeitig hohem Ressourcenverbrauch ergeben. Vor diesem Hintergrund wird in diesem Papier ein neu entwickeltes Instrument zur Verringerung der Auswirkungen auf die Ernährung vorgestellt, der sogenannte Ernährungsfußabdruck. Das Instrument basiert auf der Umsetzung des Konzepts einer nachhaltigen Ernährung in Entscheidungsprozessen und der Unterstützung einer ressourcenschonenden Gesellschaft. Das Konzept integriert jeweils vier Indikatoren aus den beiden ernährungsrelevanten Bereichen Gesundheit und Umwelt und verdichtet sie zu einem leicht kommunizierbaren Ergebnis, das sich in seinen Ergebnissen auf eine Wirkungsebene beschränkt. Anhand von acht Mittagsmahlzeiten werden die Methodik und ihre Berechnungsverfahren detailliert vorgestellt. Die Ergebnisse unterstreichen die allgemeine wissenschaftliche Sichtweise auf Lebensmittel; Mahlzeiten auf der Basis von tierischem Eiweiß sind im Hinblick auf ihre Gesundheits- und Umweltauswirkungen relevanter. Das Konzept scheint für Verbraucher nützlich zu sein, um ihre eigene Wahl zu bewerten, und für Unternehmen, um ihre internen Daten, ihre Benchmarking-Prozesse oder ihre externe Kommunikationsleistung zu erweitern. Methodische Unzulänglichkeiten und die Interpretation der Ergebnisse werden erörtert, und die Schlussfolgerung zeigt das Potenzial der Instrumente für die Gestaltung von Übergangsprozessen und für die Verringerung des Verbrauchs natürlicher Ressourcen durch die Unterstützung von Entscheidungen und Wahlmöglichkeiten von Lebensmittelanbietern und Verbrauchern.
The nutritional footprint – An assessment tool for health and environmental effects of nutrition
(2014)
Aufgrund seiner starken Umweltauswirkungen gilt der Lebensmittelsektor durch Effekte in Produktion, Verarbeitung, Konsum und Entsorgung gemeinhin als ein wichtiges Handlungsfeld, soll eine gesellschaftliche Transformation in Richtung Nachhaltigkeit weiter vorangetrieben werden. Da Ernährungsgewohnheiten sowohl ökologische Auswirkungen induzieren als auch gesundheitliche Folgen für die Verbraucher haben, sind Konzepte gefragt, die ökologische mit gesundheitlichen Indikatoren kombinieren; diese sind jedoch bislang rar. Das vorgestellte Instrument des Nutritional Footprint greift diese Problemstellung auf und verbindet in einem innovativen Konzept jeweils vier Kernindikatoren beider Dimensionen. Mithilfe des Konzepts erhalten Verbraucher einen Überblick zu Umwelt- und Gesundheitswirkungen ihrer Ernährung. Unternehmen können wiederum interne Datensätze verwalten, Benchmarking betreiben und ihre externe Kommunikationsleistung erweitern.
Dieser Artikel befasst sich mit dem bundesweiten Niveau der Treibhausgas (THG)-Emissionen und des Ressourcenverbrauchs in der deutschen Gemeinschaftsverpflegung im Segment "Business" und deren Einsparpotenziale durch verschiedene Szenarien der ungestützten und gestützten Rezeptüberarbeitung. Unter "ungestützt" verstehen wir in dieser Arbeit die intuitive Optimierung von Rezepten durch die Mitarbeiter von Betrieben der Gemeinschaftsverpflegung. Die "unterstützten" Ansätze mussten dagegen bestimmte Zielvorgaben erfüllen, zum Beispiel der Deutschen Gesellschaft für Ernährung; engl. Deutschen Gesellschaft für Ernährung oder das nachhaltige Niveau. Konkret Konkret wird getestet, wie sich (A) eine ungestützte Rezeptüberarbeitung, (B) eine Rezeptüberarbeitung auf Basis von Ernährungsempfehlungen und (C) eine Rezeptüberarbeitung mit wissenschaftlicher Begleitung die Umweltauswirkungen eines Gerichtes beeinflussen. Als methodischer Rahmen diente eine Online-Befragung von Unternehmen der Gemeinschaftsverpflegung sowie eine Szenarioanalyse auf Menüebene und auf nationaler Ebene durchgeführt. Die Ergebnisse basieren zum einen auf empirischen Daten und zum anderen auf Hochrechnungen. Die Ergebnisse zeigen, dass die die bundesweite Umsetzung der Rezepturüberarbeitung nach wissenschaftlichen Vorgaben - wie konkrete Zielvorgaben für die THG Emissionen pro Portion - bis zu 44% des Ressourcenverbrauchs in der deutschen Betriebsgastronomie einsparen kann (das entspricht 3,4 Millionen Tonnen Ressourcen pro Jahr) und bis zu 40 % der THG-Emissionen (0,6 Millionen Tonnen THG-Emissionen pro Jahr) einsparen.
Der Konsumbereich „Ernährung“ verantwortet in Deutschland rund 15 % der Treibhausgasemissionen (THG). Aufgrund der hohen Nachfrage hat die Außer-Haus-Verpflegung eine starke Hebelwirkung, um eine klimaeffiziente Ernährung voranzutreiben – so auch Schulküchen. Aktuell sind der Verpflegung jedes Schulkindes, welches ganzjährig an der Mittagsverpflegung teilnimmt, pro Jahr etwa 264 kg THG-Emissionen zuzuschreiben.
Im Projekt KEEKS „Klima- und energieeffiziente Küche in Schulen” wurden deshalb in 22 Schulküchen von Ganztagsschulen mit täglich insgesamt 5 000 Mittagessen der Status Quo ermittelt. Dies geschah mittels Energiemessungen, Analyse von Ausstattung, Technik und Prozessen der Küchen sowie leitfadengestützten Interviews mit den Küchenleitungen. Treibhausgasemissionen von Menüs und Küchenprozessen wurden bilanziert, Einsparpotenziale identifiziert sowie Handlungsempfehlungen entwickelt und erprobt. Die effektivsten Maßnahmen – die Reduktion und Substitution von Fleisch und Fleischprodukten sowie der Aufbau eines effizienten Abfallmanagements – sparen rund 10 % des Treibhausgasausstoßes einer Schulküche ein. Die erarbeiteten Handlungsempfehlungen können Küchenpersonal dabei unterstützen, eine klimafreundliche, kindgerechte, gesunde und bezahlbare Schulküche zu gestalten.
Background
There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care.
Methods
We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal.
Results
We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)).
Conclusions
We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS.
Are natural floods accelerators for streambank vegetationdevelopment in floodplain restoration?
(2021)
Riverbanks are very dynamic habitats for riparian vegetation strongly influenced byfluvial and geomorphic processes. This habitat type was severely reduced in the pastby river straightening and bank stabilisation. Restoration and establishment of newfloodplain streams promote this habitat, but a directed succession to later stages wasobserved many times. Our study aimed to analyse whether the often observeddirected succession of the streambank vegetation after restoration implementationcould be reversed by a natural flood along a newly created floodplain stream. Weinvestigated the effects of a natural flood in 2013 and different prerestorationconditions on species development in the riparian zone. Vegetation was studiedalong 12 transects in four different sections from 2011 to 2014. Species composi-tion differed strongly between the sections. Species richness was lowest in a newlydug steep section with high morphological dynamics and highest on wider flatstreambanks. Changes during the years reflecting different hydrological eventsvaried between sections. The high natural flood in 2013 reduced the cover of theherb layer and increased bare ground, which led in most sections to a loss of non-target species. Total target species richness did not change due to the natural flood,while target species showed a high turnover rate. In the following year, however,the flood‐induced development of species composition, in general, was reversed.Natural floods changed abiotic and biotic conditions along the streambank, but theydid not accelerate ecological restoration towards predefined target ecosystems.However, they were necessary to preserve the needed dynamic vegetation changesand species turnover to hinder the succession to later stages dominated by a fewspecies. Our study shows that riparian vegetation near the streambank can bemonitored most effectively in cross‐profile transects, both in the long‐term andevent‐related.
Objectives: To identify emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care.
Methods: Qualitative study carried out in two stages: field approach from healthcare interventions in a Recycling Materials Association, and individual interviews conducted between October and December 2018.
Results: The analysis resulted in three thematic categories: Social contribution of recyclable materials collectors; From the assistentialist perception to entrepreneurial Nursing care; Emancipatory strategies of recycling work.
Final Considerations: The emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care are related to the appreciation, recognition and enhancement of social work that has been already performed by these professionals, and to the creation of spaces for the socialization of experiences, expectations and perspectives.
Objective:
To understand the meaning of entrepreneurial nursing care as inducer of healthy practices in vulnerable communities.
Method:
Grounded theory, whose data collection took place between March and December 2019, from interviews with 19 participants from the central region of Rio Grande do Sul, Brazil and comparative data analysis.
Results:
The phenomenon was delimited: Experiencing small/big transformations in the invisibility of everyday life in promoting healthy practices in vulnerable communities. Conducted by the paradigmatic model, the categories were named based on the components: Condition: Making choices and negotiating non-negotiable exchanges; Action/interaction: Motivating oneself to maintain basic human needs; Consequence: Broadening perspectives and transcending personal and collective boundaries.
Conclusion:
Entrepreneurial nursing care as inducer of healthy practices in vulnerable communities is not reduced to a scientific theory or to the linear and decontextualized apprehension of healthy living, but extends to reach small/big transformations that occur in the invisibility of everyday life.
Objective:
to carry out a theoretical reflection on the Nursing Now Campaign and the experience of the unexpected irruptions facing the pandemic period.
Method:
a theoretical-reflective study, supported by the theoretical framework of complexity thinking. It aims at understanding the dialogic between the notions of order, disorder and organization, which translate the transition from simplification to complexity of the pandemic phenomenon and its relation to the theme of Nursing Now and Nursing in the future.
Results:
the universe of phenomena is simultaneously composed of order, disorder and organization. Reasserting the central role of Nursing in the health team, facing the irruptions and uncertainties caused by the current pandemic, implies the ability to dialog with disorder and raise a new and more complex global (re)organization of the being and doing Nursing.
Conclusion:
in addition to answers, theoretical reflection raises new questions and irruptions. The inseparability between the notions of order and disorder in the evolutionary dynamics of the Nursing system is conceived and the promotion of even more complex levels of organization, management and Nursing assistance to achieve universal access to health is advocated.
Objective: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area.
Method: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students.
Results: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator.
Conclusion: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.
Objective: To understand the significance of healthy living for users, professionals and managers of the Family Health Strategy (FHS) team.
Methods: Research of a qualitative nature, based on grounded theory. For data collection, interviews were conducted with 25 participants, including users, professionals and managers of a FHS team, during the period between March and December, 2009. Results: The collection and analysis of data was conducted in a systematic and comparative manner, demonstrating that healthy living can be characterized as a selforganizing process, mediated by the action of the FHS team professionals, especially by the community health agent, through creation of bonds of trust and stimulation of interactions and community associations. Conclusion: We concluded that healthy living is a singular phenomenon, complex, interactive, associative, political and social, coupled with the active involvement and participation of the users and by the engagement of effective and socially responsible professionals, managers and established political authorities.
One challenge of the EU energy transition is the integration of renewable electricity generation in the distribution system. EU energy law proposes a possible solution by introducing “citizen energy communities” (Directive 2019/944/EU) which may be open for “cross-border participation”. This article proposes an innovative way of implementing such cross-border communities by linking distribution systems via a “switchable element”, a generation, storage, or consumption asset with a connection to each country. An optimization model has been developed to calculate the system cost savings of such a connection. Linking regions with complementary characteristics regarding electricity generation and demand via a switchable element leads to more efficient system utilization. Findings are relevant for the transposition of “citizen energy communities” in national laws.
Die Autoren präsentieren einen innovativen Ansatz für Circular Economy (CE)-Strategien mit hohem Umweltpotenzial. Dieser Ansatz betont Verweigerung, Umdenken und Reduzieren, indem die Perspektive vom Verbraucher auf soziale Praktiken verschoben wird. Dabei wird Suffizienz als Schlüsselkonzept eingeführt, das entscheidend ist, um Umweltbelastungen durch CE zu reduzieren und die Transformation des Produktions- und Konsumsystems zu fördern. Die Autoren betonen, dass nachhaltige Kreislaufwirtschaft ohne Suffizienz nicht möglich ist.
Die Studie berichtet über einen Fall, in dem die Über-Verfügbarkeit durch das Konzept der Genügsamkeit ersetzt wurde. Die Autoren beobachten, wie Suffizienz in die Lebensstile der Teilnehmer integriert wird, insbesondere durch einen Farmboxing-Ansatz. Obwohl die Verallgemeinerung des Falls begrenzt ist, zeigt die Studie das Potenzial niedrigschwelliger Einführungen von Suffizienz, wie beispielsweise öffentlicher Raum für gärtnerische Aktivitäten.
Die Autoren betonen jedoch die Notwendigkeit weiterer empirischer Arbeit, um die Bedeutung von Suffizienz in verschiedenen sozialen Praktiken zu verstehen. Sie schlagen vor, dass der Zeitpunkt für solche Forschungen günstig ist, angesichts aktueller globaler Entwicklungen und der steigenden Nachfrage nach Strategien zur Ressourcenverringerung.
Die Studie identifiziert Herausforderungen, darunter unklare Faktoren, die nicht berücksichtigt wurden, wie die Rolle des sozialen Umfelds und die Übertragbarkeit der Ergebnisse auf andere Lebensbereiche. Die Autoren planen bereits eine Folgestudie mit quantitativen und qualitativen Analysen sowie Lebenszyklusanalysen.
Abschließend schlagen die Autoren vor, klare Definitionen für Wiederverwendung, Umdenken und Reduzierung zu entwickeln, basierend auf empirischen Daten und Beispielen sozialer Praktiken. Sie fordern auch dazu auf, Theorien sozialer Praktiken auf andere CE-Strategien anzuwenden, da soziale Praktiken nicht auf privaten Konsum beschränkt sind.
Quantitative Umweltbewertungen sind von entscheidender Bedeutung, wenn es darum geht, effektiv auf nachhaltige Produktions- und Verbrauchsmuster hinzuarbeiten. In den letzten Jahrzehnten haben sich Lebenszyklusanalysen (LCA) als praktikables Mittel zur Messung der Umweltauswirkungen von Produkten entlang der Lieferkette etabliert. In Bezug auf Nutzer- und Konsummuster wurden jedoch methodische Schwächen festgestellt, und es wurden mehrere Versuche unternommen, Ökobilanzen entsprechend zu verbessern, beispielsweise durch Einbeziehung von Effekten höherer Ordnung und verhaltenswissenschaftlicher Unterstützung. In einer Diskussion solcher Ansätze zeigen wir, dass den Konzepten des Verbrauchs keine explizite Aufmerksamkeit geschenkt wurde, was häufig zu produktzentrierten Bewertungen führt. Wir führen Theorien sozialer Praktiken ein, um Konsummuster für LCA zugänglich zu machen. Soziale Praktiken sind routinierte Handlungen, die aus miteinander verbundenen Elementen (Materialien, Kompetenzen und Bedeutungen) bestehen, die sie als eine Einheit denkbar machen (z. B. Kochen). Da die meisten sozialen Praktiken eine Art von Verbrauch (Material, Energie, Luft) beinhalten, konnten wir einen Rahmen entwickeln, der soziale Praktiken mit der Ökobilanz verbindet. Der vorgeschlagene Rahmen bietet eine neue Perspektive für quantitative Umweltbewertungen, indem er den Schwerpunkt von Produkten oder Nutzern auf soziale Praktiken verlagert. Dementsprechend sehen wir die Chance darin, die reduktionistische Sichtweise zu überwinden, dass Menschen nur Nutzer von Produkten sind, und sie stattdessen als Praktiker in sozialen Praktiken zu sehen. Dieser Wandel könnte neue Methoden der interdisziplinären Konsumforschung ermöglichen, die beabsichtigte Sozialwissenschaften und wirkungsorientierte Bewertungen einbeziehen. Allerdings bedarf der Rahmen einer weiteren Überarbeitung und vor allem einer empirischen Validierung.
Freshwater ecosystems host disproportionately high numbers of species relative to their surface area yet are poorly protected globally. We used data on the distribution of 1631 species of aquatic plant, mollusc, odonate and fish in 18,816 river and lake catchments in Europe to establish spatial conservation priorities based on the occurrence of threatened, rangerestricted and endemic species using the Marxan systematic conservation planning tool. We found that priorities were highest for rivers and ancient lakes in S Europe, large rivers and lakes in E and N Europe, smaller lakes in NW Europe and karst/limestone areas in the Balkans, S France and central Europe. The a priori inclusion of well-protected catchments resulted in geographically more balanced priorities and better coverage of threatened (critically endangered, endangered and vulnerable) species. The a priori exclusion of well-protected catchments showed that priority areas that need further conservation interventions are in S and E Europe. We developed three ways to evaluate the correspondence between conservation priority and current protection by assessing whether a cathment has more (or less) priority given its protection level relative to all other catchments. Each method found that priority relative to protection was high in S and E Europe and generally low in NW Europe. The inclusion of hydrological connectivity had little influence on these patterns but decreased the coverage of threatened species, indicating a trade-off between connectivity and conservation of threatened species. Our results suggest that catchments in S and E Europe need urgent conservation attention (protected areas, restoration, management, species protection) in the face of imminent threats such as river regulation, dam construction, hydropower development and climate change. Our study presents continental-scale conservation priorities for freshwater ecosystems in ecologically meaningful planning units and will thus be important in freshwater biodiversity conservation policy and practice, and water management in Europe.
Objectives
To investigate differences in pressure pain thresholds (PPTs) and longitudinal mechanosensitivity of the greater occipital nerve (GON) between patients with side-dominant head and neck pain (SDHNP) and healthy controls. Evaluation of neural sensitivity is not a standard procedure in the physical examination of headache patients but may influence treatment decisions.
Methods
Two blinded investigators evaluated PPTs on two different locations bilaterally over the GON as well as the occipitalis longsitting-slump (OLSS) in subjects with SDHNP (n = 38)) and healthy controls (n = 38).
Results
Pressure pain sensitivity of the GON was lower at the occiput in patients compared to controls (p = 0.001). Differences in pressure sensitivity of the GON at the nucheal line, or between the dominant headache side and the non-dominant side were not found (p > 0.05). The OLSS showed significant higher pain intensity in SDHNP (p < 0.001). In comparison to the non-dominant side, the dominant side was significantly more sensitive (p = 0.004).
Discussion
Palpation of the GON at the occiput and the OLSS may be potentially relevant tests in SDHNP. One explanation for an increased bilateral sensitivity may be sensitization mechanisms. Future research should investigate the efficacy of neurodynamic techniques directed at the GON.
Background: Lumbar discectomy is considered a safe, efficacious and cost-effective treatment for selected cases of patients with leg pain associated with the presence of a disc protrusion. But despite technically successful surgery, 30 % of patients complain of persistent pain on long-term follow up. Identification of possible predictors for a negative outcome is important, in the search for appropriate pre- and/or post-operative care and prevention of persistent disability. There is some evidence in the literature that quantitative sensory testing (QST) measures may play a role in prediction of patients’ pain persistency, however, this has never been investigated in patients undergoing lumbar discectomy.
Objective: The aim of this study is to determine the predictive value of QST parameters, in combination with previously documented predictor variables such as medical/psychological/cognitive behavioural factors, in patients with lumbar radiculopathy and/or radicular pain, for predicting patients’ clinical outcome after lumbar discectomy.
Method: Participants with radiculopathy and/or radicular pain and confirmed imaging diagnosis of nerve root compression will be recruited from the elective surgery waitlist at one hospital. All participants will undergo lumbar discectomy performed by one neurosurgeon. A standardized QST protocol comprising all of the somatosensory sub-modalities that are mediated by different primary afferents (C-, Aδ-, Aβ-) will be performed prior to surgery. QST will be conducted in the patients’ main pain area and contralateral side, in the affected dermatome and at a remote control site. The presence of other predictor variables will be captured by questionnaires. Follow-up at 3 months will include QST and measurements of pain intensity, pain descriptors, functional status, health related quality of life, return to work and health care utilisation. A further 1-year follow-up will include the same measurements except QST.
Results/Conclusions: Identification of new predictor variables may assist in the development of pre-surgical screening methods and in targeted pre- and/or post-operative patient care, with the potential to improve patients’ functional status, quality of life, work capacity whilst also reducing health care costs associated with persistent disability
Identification of differences in clinical presentation and underlying pain mechanisms may assist the classification of patients with neck–arm pain which is important for the provision of targeted best evidence based management. The aim of this study was to: (i) assess the inter-examiner agreement in using specific systems to classify patients with cervical radiculopathy and patients with non-specific neck–arm pain associated with heightened nerve mechanosensitivity (NSNAP); (ii) assess the agreement between two clinical examiners and two clinical experts in classifying these patients, and (iii) assess the diagnostic accuracy of the two clinical examiners. Forty patients with unilateral neck–arm pain were examined by two clinicians and classified into (i) cervical radiculopathy, (ii) NSNAP, (iii) other. The classifications were compared to those made independently by two experts, based on a review of patients' clinical assessment notes. The experts' opinion was used as the reference criterion to assess the diagnostic accuracy of the clinical examiners in classifying each patient group. There was an 80% agreement between clinical examiners, and between experts and 70%–80% between clinical examiners and experts in classifying patients with cervical radiculopathy (kappa between 0.41 and 0.61). Agreement was 72.5%–80% in classifying patients with NSNAP (kappa between 0.43 and 0.52). Clinical examiners' diagnostic accuracy was high (radiculopathy: sensitivity 79%–84%; specificity 76%–81%; NSNAP: sensitivity 78%–100%; specificity 71%–81%). Compared to expert opinion, clinicians were able to identify patients with cervical radiculopathy and patients with NSNAP in 80% of cases, our data supporting the reliability of these classification systems.
Background: The painDETECT questionnaire (PD-Q) has been used as a tool to characterize sensory abnormalities in patients with persistent pain. This study investigated whether the self-reported sensory descriptors of patients with painful cervical radiculopathy (CxRAD) and patients with fibromyalgia (FM), as characterized by responses to verbal sensory descriptors from PD-Q (sensitivity to light touch, cold, heat, slight pressure, feeling of numbness in the main area of pain), were associated with the corresponding sensory parameters as demonstrated by quantitative sensory testing (QST).
Methods: Twenty-three patients with CxRAD (eight women, 46.3 ± 9.6 years) and 22 patients with FM (20 women, 46.1 ± 11.5 years) completed the PD-Q. Standardized QST of dynamic mechanical allodynia, cold and heat pain thresholds, pressure pain thresholds, mechanical and vibration detection thresholds, was recorded from the maximal pain area. Comparative QST data from 31 age-matched healthy controls (HCs; 15 women) were obtained.
Results: Patients with CxRAD demonstrated a match between their self-reported descriptors and QST parameters for all sensory parameters except for sensitivity to light touch, and these matches were statistically significant compared with HC data (p ≤ 0.006). The FM group demonstrated discrepancies between the PD-Q and QST sensory phenotypes for all sensory descriptors, indicating that the self-reported sensory descriptors did not consistently match the QST parameters (p = ≤0.017).
Conclusion: Clinicians and researchers should be cautious about relying on PD-Q as a stand-alone screening tool to determine sensory abnormalities in patients with FM.
Background and aims
In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q.
Methods
In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools.
Results
The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%).
Conclusions
The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice.
Implications
Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.
Background/Aim
This study aimed to establish the somatosensory profile of patients with lumbar radiculopathy at pre-and post-microdiscectomy and to explore any association between pre-surgical quantitative sensory test (QST) parameters and post-surgical clinical outcomes.
Methods
A standardized QST protocol was performed in 53 patients (mean age 38 ± 11 years, 26 females) with unilateral L5/S1 radiculopathy in the main pain area (MPA), affected dermatome and contralateral mirror sites and in age- and gender-,and body site-matched healthy controls. Repeat measures at 3 months included QST, the Oswestry Disability Index (ODI) and numerous other clinical measures; at 12 months, only clinical measures were repeated. A change <30% on the ODI was defined as ‘no clinically meaningful improvement’.
Results
Patients showed a significant loss of function in their symptomatic leg both in the dermatome (thermal, mechanical, vibration detection p < .002), and MPA (thermal, mechanical, vibration detection, mechanical pain threshold, mechanical pain sensitivity p < .041) and increased cold sensitivity in the MPA (p < .001). Pre-surgical altered QST parameters improved significantly post-surgery in the dermatome (p < .018) in the symptomatic leg and in the MPA (p < .010), except for thermal detection thresholds and cold sensitivity. Clinical outcomes improved at 3 and 12 months (p < .001). Seven patients demonstrated <30% change on the ODI at 12 months. Baseline loss of function in mechanical detection in the MPA was associated with <30% change on the ODI at 12 months (OR 2.63, 95% CI 1.09–6.37, p = .032).
Conclusion
Microdiscectomy resulted in improvements in affected somatosensory parameters and clinical outcomes. Pre-surgical mechanical detection thresholds may be predictive of clinical outcome.
Significance
This study documented quantitative sensory testing (QST) profiles in patients with lumbar radiculopathy in their main pain area (MPA) and dermatome pre- and post-microdiscectomy and explored associations between QST parameters and clinical outcome. Lumbar radiculopathy was associated with loss of function in modalities mediated by large and small sensory fibres. Microdiscectomy resulted in significant improvements in loss of function and clinical outcomes in 85% of our cohort. Pre-surgical mechanical detection thresholds in the MPA may be predictive of clinical outcome.
15 δ N signals in plant and soil material integrate over a number of biogeochemical processes
related to nitrogen (N) and therefore provide information on net effects of multiple
processes on N dynamics. In general little is known in many grassland restoration projects
on soil–plant N dynamics in relation to the restoration treatments. In particular, 15 δ N signals
may be a useful tool to assess whether abiotic restoration treatments have produced the
desired result. In this study we used the range of abiotic and biotic conditions provided
by a restoration experiment to assess to whether the restoration treatments and/or plant
functional identity and legume neighborhood affected plant 15 δ N signals. The restoration
treatments consisted of hay transfer and topsoil removal, thus representing increasing
restoration effort, from no restoration measures, through biotic manipulation to major
abiotic manipulation. We measured 15 δ N and %N in six different plant species (two nonlegumes and four legumes) across the restoration treatments. We found that restoration
treatments were clearly reflected in 15 δ N of the non-legume species, with very depleted
15 δ N associated with low soil N, and our results suggest this may be linked to uptake of
ammonium (rather than nitrate). The two non-legume species differed considerably in their
15 δ N signals, which may be related to the two species forming different kinds of mycorrhizal
symbioses. Plant 15 δ N signals could clearly separate legumes from non-legumes, but our
results did not allow for an assessment of legume neighborhood effects on non-legume
15 δ N signals. We discuss our results in the light of what the 15 δ N signals may be telling
us about plant–soil N dynamics and their potential value as an indicator for N dynamics in
restoration.
Injection of slurry or digestate below maize seeds is a relatively new technique developed to improve nitrogen use efficiency. However, this practice has the major drawback of increasing nitrous oxide (N2O) emissions. The application of a nitrification inhibitor (NI) is an effective method to reduce these emissions. To evaluate the effect of the NI 3,4‐dimethypyrazole phosphate (DMPP) on N2O emissions and the stabilization of ammonium, a two‐factorial soil‐column experiment was conducted. PVC pipes (20 cm diameter and 30 cm length) were used as incubation vessels for the soil‐columns. The trial consisted of four treatments in a randomized block design with four replications: slurry injection, slurry injection + DMPP, digestate injection, and digestate injection + DMPP. During the 47‐day incubation period, N2O fluxes were measured twice a week and cumulated by linear interpolation of the gas‐fluxes of consecutive measurement dates. After completion of the gas flux measurement, concentration of ammonium and nitrate within the soil‐columns was determined. DMPP delayed the conversion of ammonium within the manure injection zone significantly. This effect was considerably more pronounced in treatment digestate + NI than in treatment slurry + NI. Regarding the cumulated N2O emissions, no difference between slurry and digestate treatments was determined. DMPP reduced the release of N2O significantly. Transferring the results into practice, the use of DMPP is a promising way to reduce greenhouse gas emissions and nitrate leaching, following the injection of slurry or digestate.
Easy and inexpensive methods for measuring ammonia emissions in multi-plot field trials allow the comparison of several treatments with liquid manure application. One approach that might be suitable under these conditions is the dynamic tube method (DTM). Applying the DTM, a mobile chamber system is placed on the soil surface, and the air volume within is exchanged at a constant rate for approx. 90 s. with an automated pump. This procedure is assumed to achieve an equilibrium ammonia concentration within the system. Subsequently, a measurement is performed using an ammonia-sensitive detector tube. Ammonia fluxes are calculated based on an empirical model that also takes into account the background ammonia concentration measured on unfertilized control plots. Between measurements on different plots, the chamber system is flushed with ambient air and cleaned with paper towels to minimize contamination with ammonia. The aim of this study was to determine important prerequisites and boundary conditions for the application of the DTM.
We conducted a laboratory experiment to test if the ammonia concentration remains stable while performing a measurement. Furthermore, we investigated the cleaning procedure and the effect of potential ammonia carryover on cumulated emissions under field conditions following liquid manure application. The laboratory experiment indicated that the premeasurement phase to ensure a constant ammonia concentration is not sufficient. The concentration only stabilized after performing more than 100 pump strokes, with 20 pump strokes (lasting approximately 90 s) being the recommendation.
However, the duration of performing a measurement can vary substantially, and linear conversion accounts for those differences, so a stable concentration is mandatory. Further experiments showed that the cleaning procedure is not sufficient under field conditions. Thirty minutes after performing measurements on high emitting plots, which resulted in an ammonia concentration of approx.
10 ppm in the chamber, we detected a residual concentration of 2 ppm. This contamination may affect measurements on plots with liquid manure application as well as on untreated control plots. In a field experiment with trailing hose application of liquid manure, we subsequently demonstrated that the calculation of cumulative ammonia emissions can vary by a factor of three, depending on the degree of chamber system contamination when measuring control plots. When the ammoni background values were determined by an uncontaminated chamber system that was used to measure only control plots, cumulative ammonia emissions were approximately 9 kg NH3-N ha1.
However, when ammonia background values were determined using the contaminated chamber system that was also used to measure on plots with liquid manure application, the calculation of cumulative ammonia losses indicated approximately 3 kg NH3-N ha1. Based on these results, it can be concluded that a new empirical DTM calibration is needed for multi-plot field experiments with high-emitting treatments.
Purpose
This paper aims to investigate the strategic consequences of manufacturing location decisions, with a focus on understanding the link between collocating manufacturing with other value chain activities, via reshoring or retaining and organizational agility.
Design/methodology/approach
The paper uses qualitative data from 115 interviews with executives from UK high value manufacturing companies to explore the recent phenomenon of reshoring and the strategic effects of manufacturing location.
Findings
The location of manufacturing is operationally and strategically important for multinational companies. The spatial dispersion of manufacturing is determined by firm-specific and external factors, both of which are subject to constant change. The analysis shows that concentrating on manufacturing in their home countries enables firms to increase organizational agility and stimulate innovation. Better integration with and more extensive collaboration between related value chain activities, such as research and development, sales and marketing, leads to higher flexibility, speed and responsiveness to customer requirements. However, under certain conditions, firms also continue to benefit from the known advantages of offshoring.
Originality/value
This research sheds light on possible strategic downsides of global value chains, characterized by dispersed activities and intermitted processes. The results provide evidence that retaining manufacturing or bringing back manufacturing operations to a company’s home country can increase organizational flexibility, speed, adaptability, innovativeness and responsiveness to customer requirements. As these capabilities are critical for long-term survival, especially in dynamic environments, firms need to review their global factory configurations and determine whether the short-term advantages of foreign locations continue to justify offshoring practices.
Usability is a core construct of website evaluation and inherently defined as interactive. Yet, when analysing first impressions of websites, expected usability, i.e., before use, is of interest. Here we investigate to what extend ratings of expected usability are related to (a) experienced usability, i.e., ratings after use, and (b) objective usability measures, i.e., task performance. Furthermore, we try to elucidate how ratings of expected usability are correlated to aesthetic judgments. In an experiment, 57 participants submitted expected usability ratings after the presentation of website screenshots in three viewing-time conditions (50, 500, and 10,000 ms) and after an interactive task (experienced usability). Additionally, objective usability measures (task completion and duration) and subjective aesthetics evaluations were recorded for each website. The results at both the group and individual level show that expected usability ratings are not significantly related either to experienced usability or objective usability measures. Instead, they are highly correlated with aesthetics ratings. Taken together, our results highlight the need for interaction in empirical website usability testing, even when exploring very early usability impressions. In our study, user ratings of expected usability were no valid proxy neither for objective usability nor for experienced website usability.
Background
Against the background of a steadily increasing degree of digitalization in health care, a professional information management (IM) is required to successfully plan, implement, and evaluate information technology (IT). At its core, IM has to ensure a high quality of health data and health information systems to support patient care.
Objectives
The goal of the present study was to define what constitutes professional IM as a construct as well as to propose a reliable and valid measurement instrument.
Methods
To develop and validate the construct of professionalism of information management (PIM) and itsmeasurement, a stepwise approach followed an established procedure from information systems and behavioral research. The procedure included an analysis of the pertaining literature and expert rounds on the construct and the
instrument, two consecutive and comprehensive surveys at the national and international level, exploratory and confirmatory factor analyses as well as reliability and validity testing.
Results
Professionalism of information management was developed as a construct consisting of the three dimensions of strategic, tactical, and operational IMas well as of the regularity and cyclical phases of IM procedures as the two elements of professionalism.
The PIM instrument operationalized the construct providing items that incorporated IM procedures along the three dimensions and cyclical phases. These procedures had to be evaluated against their degree of regularity in the instrument. The instrument proved to be reliable and valid in two consecutive measurement phases
and across three countries.
Conclusion
It can be concluded that professionalism of information management is a meaningful construct that can be operationalized in a scientifically rigorous manner. Both science and practice can benefit from these developments in terms of improved self-assessment, benchmarking capabilities, and eventually, obtaining a better understanding of health IT maturity.
Professionalization in low-threshold drug aid : between managerialism and practitioner knowledge
(2021)
In this experimental work, the quasi static and fatigue properties of a 40 wt.% long carbon fiber reinforced partially aromatic polyamide (Grivory GCL-4H) were investigated. For this purpose, microstructural parameter variations in the form of different thicknesses and different removal directions from injectionmolded plates were evaluated. Mechanical properties decreased by increasing misalignment away from the melt flow direction. By changing the specimen thickness, no change in the general fiber distribution pattern transversal and normal to the axis of melt flow was observed. It has shown that with increasing specimen thickness the quasi static properties along the melt flow direction decreased and vice versa resulting in superior properties normal to the melt flow axis. At around 5 mm, an intersection suggests quasi-isotropic behavior. In addition, the fatigue strength of the material was significantly higher in the flow direction than normal to the flow direction. No change in fatigue life was observed while changing specimen thickness. The Basquin equation seems to describe the effect of stress amplitude on the fatigue strength of this composite. Scanning electron microscopy was used to investigate fracture surfaces of tested specimens. Results show that mechanical properties and morphological structures depend highly on fiber orientation.
Background:
Children with severe psychomotor impairment (SPMI) often experience sleep disturbances that severely distress both the child and his or her parents. Validated questionnaires for the assessment of parents’ distress related to their child’s sleep disturbances are lacking.
Methods:
We developed and validated a new questionnaire, the HOST (holistic assessment of sleep and daily troubles in parents of children with SPMI) to assess the effect of the sleep disturbances in children with SPMI on their parents. The questionnaire was developed based on published data and expert opinion, and it was refined via direct consultation with affected parents. Its psychometric characteristics were assessed in a sample of parents of 214 children with SPMI. It was retested using a random subsample of the participants.
Results:
Explorative factor analysis revealed that the HOST was composed of four scales. Fit indices, item analysis, and convergent validity (coherence with preexisting instruments of sleep disturbances and health status) were adequate. Retest analysis (n = 62) revealed high stability of the HOST questionnaire and adequate replication validity.
Conclusion:
Sleep-related difficulties significantly impact the sociomedical characteristics of the parents of children with complex neurologic diseases. Typically, parents are severely affected in various aspects of daily life (i.e., medical health, social life, professional life). The HOST proved to be a valid, reliable and economical assessment tool of sleep-related difficulties in parents and relatives of children with SPMI. The HOST is capable of identifying individuals and specific areas requiring intervention.
Background
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
Methods
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
Results
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Conclusions
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
Objectives: The aims of this study were to define the Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) scores associated with no pain, mild pain, moderate pain, and severe pain in children with acute pain, and to identify differences based on age, sex, and ethnicity.
Methods: We conducted a prospective observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions. We assessed their pain intensity using the FPS-R, CAS, and qualitative measures. Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic-based method. Cut points were compared within subgroups based on age, sex, and ethnicity.
Results: We enrolled 620 patients, of whom 314 had painful conditions. The mean age was 9.2 years; 315 (50.8%) were in the younger age group (aged 4-7 years); 291 (46.8%) were female; and 341 (55%) were Hispanic. The scores best representing categories of pain for the FPS-R were as follows: no pain, 0 and 2; mild pain, 4; moderate pain, 6; and severe pain, 8 and 10. For the CAS, these were 0 to 1, 1.25 to 2.75, 3 to 5.75, and 6 to 10, respectively. Children with no pain frequently reported nonzero pain scores. There was considerable overlap of scores associated with mild and moderate pain. There were no clinically meaningful differences of scores representing each category of pain based on age, ethnicity, and race.
Conclusions: We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics. There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention.
Clinically Significant Differences in Acute Pain Measured on Self-report Pain Scales in Children
(2015)
Objectives
The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale–Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics.
Methods
This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS−R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with “a little less” and “much less” pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic–based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain intensity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain.
Results
A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain intensity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain.
Conclusions
The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain intensity, therefore limiting their potential generalizability.
Species dispersal, establishment, and assembly are crucial stages of the life history of plants, and clear understanding ofthe governing forces and rules that shape species composition in a particular community is vital for successful ecologicalrestoration. In this article, we focus on five aspects of seed dispersal and plant establishment, which should be consideredduring habitat restoration actions. In the first two sections, we discuss the success of spontaneous dispersal and establishmenton restoration based on either spatial dispersal or local seed banks. In the third section, we assess the possibilities ofspecies introduction and assisted dispersal. In the fourth section, we introduce some possibilities for the improvement ofestablishment success of spontaneously dispersed or introduced species. Finally, we highlight issues influencing long-termpersistence and sustainability of restored habitats, related to the alteration of management type and intensity, climate change,and spread of non-native species. With the present article, we introduce the special issue entitled “Seed dispersal and soil seedbanks – promising sources for ecological restoration” containing 15 papers by 62 authors from 10 countries arranged in theabovementioned five topics.
Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery. Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1–2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay. Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54–13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85–3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone. Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered.
Attitudes Concerning Postmortem Organ Donation : A Multicenter Survey in Various German Cohorts
(2015)
BACKGROUND
The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts.
MATERIAL AND METHODS
Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family.
RESULTS
Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants’ attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information.
CONCLUSIONS
Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem.